Arianna Ritchey, RDH
DRY SOCKET: The Absolute Worst.
Last July we featured an awesome article by Becky that was all about wisdom teeth. If you haven’t read it yet, here’s the link! Becky touched on one of the complications following a wisdom tooth extraction, called a “dry socket.” The technical term for a dry socket is Alveolar Osteitis, which directly translated means ‘inflammation of alveolar bone (of the jaw).’
A dry socket is a complication which occurs after about 25% of wisdom tooth extractions, and is more common in the lower jaw than the upper jaw. The incidence of a dry socket resulting from the extraction of any other teeth is considerably lower; only two to three percent. The symptoms of dry socket include a bad taste in the mouth, a dry-looking socket with white-ish bone at the bottom instead of a dark red blood clot, and pain that progressively becomes more severe and can sometimes radiate to other parts of the head and neck. Symptoms typically occur about two to three days after the extraction and are often uncontrollable with over-the-counter pain medication. If you have ever experienced a dry socket, then you already know that the pain is excrutiating. So, what exactly is a dry socket? Why does it happen, how can it be prevented, and most importantly, how can it be treated?
When a tooth is pulled, what’s left behind is an empty socket site in the bone where the roots of the tooth used to be. Following the extraction, a blot clot forms in the socket site and protects the underlying bone and nerves from exposure to the mouth. Over time, the socket site heals and is filled in with new bone. If this blood clot is lost prematurely, however, the underlying bone and nerves are exposed to the environment of the mouth, which is crawling with bacteria. This exposure can lead to infection and the dreaded dry socket. Dry socket is more prevalent in the lower jaw than the upper jaw, because the lower jaw has a poorer blood supply than the upper jaw, and food debris is more likely to become trapped in socket sites due to gravity.
Following an extraction, dental professionals provide post-operative instructions in the interest of preventing a dry socket. They will advise to avoid any foods with small seeds or nuts which could get trapped in the socket site, avoid strenuous activity following surgery to prevent additional bleeding, and to avoid vigorous rinsing that could potentially dislodge the blood clot. Instruction will be given to avoid spitting or drinking through a straw for at least two or three days. Spitting and using a straw creates negative pressure in the mouth which could dislodge a clot. Your dental professional will likely also tell you to avoid the use of tobacco at all costs, especially cigarette smoking. Smoking also creates negative pressure in the mouth which could dislodge a clot, and the nicotine in the cigarette slows healing and constricts blood flow necessary for proper healing.
Besides providing helpful instructions for how a dry socket can be prevented at home, your dental health professional can also help to prevent dry socket from occurring by placing a small suture in the extraction site if necessary, and by rinsing with an antimicrobial chlorhexidine rinse immediately after the extraction. Rinsing with chlorhexidine solution after extractions has been shown to prevent about 40% of potential dry sockets.
Despite dry socket being very painful, the treatment is fairly simple. If you think you may be experiencing dry socket, call your dental provider right away. Once they determine a dry socket is present, your dental professional will clean the socket site and apply a medicated dressing. Your dental professional may administer a local anesthetic to the area to provide pain relief and to facilitate cleaning and medicating the site without causing further discomfort. The medicated dressing often includes eugenol, an ingredient which is very soothing for dry socket. Your dentist may provide a prescription for antibiotics or pain medication to assist with recovery from the dry socket. If a dry socket is left untreated, it may resolve on its own, but the pain is likely to last for about a week.
Dry socket is a very painful complication that should be avoided with every effort. If preventive efforts are made, and post-op instructions are adhered to, there’s a good chance you won’t experience a dry socket. If your extraction site does start to hurt after about two or three days and over-the-counter medication isn’t controlling the pain, you may have a dry socket and should see your dentist as soon as possible! Dry socket is easily treatable by dental professionals.
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